Patient-reported outcomes and framework fit accuracy of removable partial dentures fabricated using digital techniques: A systematic review and meta-analysis.

PURPOSE: This review aimed to summarize the evidence on patient-reported outcomes and clinical performance of digitally fabricated removable partial dentures (RPDs) compared to traditionally fabricated dentures. METHODS: Three databases were systematically searched (PubMed, CENTRAL, and Wiley online library) for clinical studies comparing digitally and conventionally fabricated RPDs regardless of data acquisition methods used for fabrication. The Cochrane Collaboration risk of bias assessment tool 2 and the Oxford Center for Evidence-based Medicine tool were used to assess risk of bias, and level of evidence, respectively. Descriptive narrative analysis was used to summarize data on patient-reported outcomes, as there were inadequate studies to pool data in a meta-analysis. A random-effects model was used to analyze the data of framework fit accuracy. RESULTS: Ten randomized controlled trials were included in the systematic review, and 4 were included in the meta-analysis. Two studies showed that digitally fabricated RPDs are associated with higher patient satisfaction than conventionally fabricated RPDs (with a mean difference of 12.5 mm on a 100-satisfaction scale, p = .008). The pooled standardized mean difference for framework fit accuracy was 0.49 (p = 0.02) in favor of conventionally fabricated RPDs, which showed that conventionally fabricated RPDs have a quantitatively better fit compared to digitally fabricated RPDs. However, clinical evaluation studies showed that both frameworks have clinically acceptable fit. CONCLUSIONS: Current evidence shows that digitally fabricated RPDs are associated with higher patient satisfaction compared to conventionally fabricated RPDs. However, the scarcity of literature here warrants the generalization of this conclusion. Both digitally and conventionally fabricated metal RPD frameworks showed acceptable fit clinically.

Tooth Shade Preferences among the General Public.

PURPOSE: To identify laypersons' most preferred tooth shade as a function of observer and patient factors, namely patients' skin shade and observers' socio-demographics. MATERIALS AND METHODS: Two online surveys using computer-designed perioral images with different shades of the skin and teeth were distributed to participants in Montreal (Canada) and San Francisco (USA). The first survey (n = 120) was designed to assess public preferences of tooth shade value, hue and chroma as a function of the skin color of the perioral image (model), and the demographic characteristics of the observer. The first survey included 6 sets of 9 identical perioral images. A different skin shade (from very dark to very light) was used for each set of images, and each set of images presented teeth with different tooth shades which included three different levels of value (2M1, 3M1, 4M1), hue (3L1.5, 3M1, 3R1.5), and chroma (3M1, 3M2, 3M3) of the Vita 3D Master shade guide. Participants were asked to choose their preferred image for each category (value, hue, chroma) within each set of skin shades. A second survey was performed to pinpoint the tooth shade that is preferred the most by the general public. In this survey, images with four tooth shades (1M1, 2M1, 3M1, 4M1) and 6 skin shades were distributed (n = 70). Ordinal logistic regression was used to identify significant predictors of preferred tooth shades. RESULTS: Most of the participants preferred teeth with the highest value (54%), a neutral hue (59%) and the lowest chroma (89%). About 75% of the participants preferred 1M1 the lightest tooth shade over other shades regardless of their demographics or skin color of the model. Among the observer-related variable, age was the most significant predictor of people preferred tooth shade (p = 0.019). CONCLUSION: This study showed that there are common preferences in terms of tooth shade value, hue and chroma among participants regardless of demographic variables and facial skin shades. This data could guide dentists for tooth shade selection in the clinical practice.

Patient-Reported Outcomes of Metal and Acrylic Resin Removable Partial Dentures: A Systematic Review and Meta-Analysis.

PURPOSE: Metal removable partial dentures (RPDs) are often considered long-term treatment options for partially edentulous patients, while acrylic resin RPDs are considered interim treatments. The aim of this review was to compare metal and acrylic resin RPDs regarding patient-reported outcomes for partially edentulous individuals. MATERIALS AND METHODS: Four databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were systematically searched for observational studies and randomized controlled trials comparing patient-reported outcomes between metal and acrylic resin RPDs. The primary outcome was patient satisfaction. Included studies were assessed for risk of bias using the Cochrane risk of bias in nonrandomized studies of interventions tool (ROBINS-I) and the Cochrane Collaboration Risk of Bias Tool for Randomized Controlled Trials. The level of evidence was evaluated using Oxford Center for Evidence-based Medicine tool. A random-effects model was used to analyze the data. RESULTS: A total of 15 studies were included in the systematic review; 10 in the meta-analysis. The pooled effect size for patient satisfaction and oral health-related quality of life showed no statistical significant difference between metal and acrylic resin dentures (0.22, 95% confidence interval -0.01, 0.45, p = 0.06; 1.45, 95% confidence interval -2.43, 5.33, p = 0.46, respectively). Compliance with using RPDs was significantly higher in patients with metal compared to patients with acrylic resin dentures (pooled odds ratio = 0.57, 95% confidence interval 0.45, 0.73, p < 0.001). Most studies had critical to serious risk of bias and low level of evidence. CONCLUSIONS: The reviewed studies showed that there was no significant difference between metal and acrylic resin RPDs in patient satisfaction and oral health-related quality of life. Metal dentures were associated with higher patient compliance rates and were preferred more by patients compared to acrylic resin dentures. However, the reviewed studies had low levels of evidence and therefore, high-quality randomized controlled trials are needed to conclusively address the question of this review.

Development of a Checklist to Prevent Reconstructive Errors Made By Undergraduate Dental Students.

PURPOSE: To design a checklist in order to reduce the frequency of reconstructive preventable errors (PE) performed by undergraduate dental students at McGill University. MATERIALS AND METHODS: The most common PE occurring at a university dental clinic were identified by three reviewers analyzing the refunded cases, and used to create a preliminary checklist. This checklist was then validated by a panel of dental educators to produce a finalized 20-item checklist. The 20-question checklist was then submitted to students in a cross-sectional survey-based study to evaluate its relevance to undergraduate clinical education needs. RESULTS: As many as 81% of students reported to have forgotten at least one item of the checklist during care of their last patient, and the most forgotten checklist items corresponded to the pretreatment stage. The students also reported that 17 of the 20 items in the checklist were relevant to a considerable extent or highly relevant. CONCLUSION: Common PE identified in the undergraduate clinic could be used to create a checklist of relevant items designed to reduce errors made by students and practitioners performing prosthodontic and reconstructive treatments. However, further studies are required to evaluate the implementation and efficiency of the checklist.

Patient satisfaction with laser-sintered removable partial dentures: A crossover pilot clinical trial.

STATEMENT OF PROBLEM: Clinical data regarding newly introduced laser-sintered removable partial dentures (RPDs) are needed before this technique can be recommended. Currently, only a few clinical reports have been published, with no clinical studies. PURPOSE: This clinical trial compared short-term satisfaction in patients wearing RPDs fabricated with conventional or computer-aided design and computer-aided manufacturing (CAD-CAM) laser-sintering technology. MATERIAL AND METHODS: Twelve participants with partial edentulism were enrolled in this pilot crossover double-blinded clinical trial. Participants were randomly assigned to wear cast or CAD-CAM laser-sintered RPDs for alternate periods of 30 days. The outcome of interest was patient satisfaction as measured using the McGill Denture Satisfaction Instrument. Assessments was conducted at 1, 2, and 4 weeks. The participant's preference in regard to the type of prosthesis was assessed at the final evaluation. The linear mixed effects regression models for repeated measures were used to analyze the data, using the intention-to-treat principle. To assess the robustness of potential, incomplete adherence, sensitivity analyses were conducted. RESULTS: Statistically significant differences were found in patients' satisfaction between the 2 methods of RPD fabrication. Participants were significantly more satisfied with laser-sintered prostheses than cast prostheses in regard to general satisfaction, ability to speak, ability to clean, comfort, ability to masticate, masticatory efficiency, and oral condition (P<.05). At the end of the study, 5 participants preferred the laser-sintered, 1 preferred the cast RPD, and 3 had no preference. CONCLUSIONS: The use of CAD-CAM laser-sintering technology in the fabrication of removable partial dentures may lead to better outcomes in terms of patient satisfaction in the short term. The conclusion from this pilot study requires confirmation by a larger randomized controlled trial. CLINICAL TRIAL: ClinicalTrials.gov. A study about patient satisfaction with laser-sintered removable partial dentures; NCT02769715.

Effect of surface treatment and type of cement on push-out bond strength of zirconium oxide posts.

STATEMENT OF PROBLEM: The effect of the surface treatment of zirconium oxide posts on their push-out bond strength is controversial. PURPOSE: The purpose of this study was to compare the effects of 2 surface treatments on the bond strength of zirconium oxide posts cemented with different cements and to assess the failure mode. MATERIAL AND METHODS: Seventy extracted human teeth were divided into 7 groups (n=10). Custom zirconium oxide posts (Cercon; Degudent) were fabricated for 6 groups. Posts in 3 groups were airborne-particle abraded (A). Posts in the other 3 groups were tribochemical silica coated (T). Three cements were used. Zinc phosphate cement was used to cement the zirconium oxide posts in groups AZ and TZ, RelyX ARC cement was used in groups ARA and TRA, and RelyX Unicem cement was used in groups ARU and TRU. Group C contained custom metal posts cemented with zinc phosphate cement. Specimens were horizontally sectioned into 3 sections and subjected to a push-out test. A mixed model analysis of variance, 1-way ANOVA, and the Tukey multiple comparison tests were used for statistical analysis. RESULTS: The highest push-out bond strength was recorded for Group ARU (21.03 MPa), and the lowest was recorded for Group ARA (7.57 MPa). No significant difference in push-out bond strength was found among the different surface treatments and root regions (P>.05). The type of cement had a significant effect on the push-out bond strength of zirconium oxide posts (P=.049). RelyX Unicem cement recorded (19.57 ±8.83 MPa) significantly higher push-out bond strength compared with zinc phosphate (9.95 ±6.31 MPa) and RelyX ARC cements (9.39 ±5.45 MPa). Adhesive failure at the post-cement interface was recorded for 75% of the posts cemented with zinc phosphate and RelyX ARC cements, while mixed failure was recorded for 75% of the posts cemented with RelyX Unicem cement. CONCLUSIONS: The type of cement used resulted in a statistically significant difference in the push-out bond strength of zirconium oxide posts, while both the surface treatment and root region resulted in no statistically significant effect after artificial aging. RelyX Unicem cement had significantly higher push-out bond strength than did zinc phosphate and RelyX ARC cements.

Educational environment as perceived by dental students at King Saud University.

OBJECTIVES: Main objectives of the present study were to develop a baseline information about dental students' perception of their educational environment at the College of Dentistry, King Saud University (KSU) in Riyadh; and to investigate the role of four different variables on the students' perception. METHODS: Dundee Ready Education Environment Measure (DREEM) questionnaire was distributed among 497 undergraduate dental students, in the second week of the first semester of the academic year, from second year students to interns studying in the College of Dentistry of King Saud University (KSU). RESULTS: Response rate was 60.73%. Mean for the total DREEM scores was 108.42/200. DREEM subscales mean were above 50% of the total score. DREEM overall score showed no significant statistical difference among the four variables investigated, except the academic year, where the second year students scored significantly higher (118.36 ±â€¯15.8) compared to the interns (105 ±â€¯21.3). CONCLUSION: Students' perception of educational environment in the KSU College of Dentistry was satisfactory. However, several weak areas were identified which need some attention and consideration.

Effect of types of luting agent on push-out bond strength of zirconium oxide posts.

OBJECTIVE: The aim of this study was to investigate the effect of different luting agents on the bond strength of zirconium oxide posts in root canals after artificial ageing. MATERIAL AND METHODS: Thirty single-rooted extracted teeth were collected. Post spaces were prepared. Custom milled zirconium oxide posts (Cercon, Degudent) were fabricated. Specimens were divided into 3 groups (n=10), according to the luting agents used: group RA, conventional resin luting agent (RelyX ARC); group RU, self-adhesive resin luting agent (RelyX Unicem); and group Z, zinc phosphate luting agent (DeTrey). Specimens were subjected to thermocycling and water storage at 37°C. Specimens were horizontally sectioned into three sections and subjected to a push-out test with 0.5mm/min crosshead speed. The failure mode was assessed by scanning electron microscopy. Data were analysed by using 2-way ANOVA. RESULTS: The following bond strength values were obtained: group RA - 8.89 MPa, group RU - 10.30 MPa and group Z - 9.31 MPa. There was no significant difference in bond strength among the groups (P=0.500). Adhesive failure mode at the cement/post bonded interface was seen in 100%, 66.67% and 83.3% of examined sections in groups RA, RU and Z, respectively. There was no significant difference in bond strength among different root regions (P=0.367). CONCLUSION: The type of luting agent had no significant effect on the push-out bond strength of zirconium oxide posts after artificial ageing. CLINICAL SIGNIFICANCE: Conventional luting agents, such as zinc phosphate cement, seem to provide comparable retention to resin luting agents for cementing custom milled zirconium oxide posts.